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Egger ST, Bobes J, Seifritz E, Vetter S, Schuepbach D. Functional transcranial Doppler: Selection of methods for statistical analysis and representation of changes in flow velocity. Health Sci Rep 2021; 4:e400. [PMID: 34632099 PMCID: PMC8493565 DOI: 10.1002/hsr2.400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 08/10/2021] [Accepted: 09/01/2021] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Transcranial Doppler (TCD) is a method used to study cerebral hemodynamics. In the majority of TCD studies, regression analysis and analysis of variance are the most frequently applied statistical methods. However, due to the dynamic and interdependent nature of flow velocity, nonparametric tests may allow for better statistical analysis and representation of results. METHOD The sample comprised 30 healthy participants, aged 33.87 ± 7.48 years; with 33% (n = 10) females. During a visuo-motor task, the mean flow velocity (MFV) in the middle cerebral artery (MCA) was measured using TCD. The MFV was converted to values relative to the resting state. The results obtained were analyzed using the general linear model (GLM) and the general additional model (GAM). The fit indices of both analysis methods were compared with each other. RESULTS Both MCAs showed a steady increase in MFV during the visuo-motor task, smoothly returning to resting state values. During the first 20 seconds of the visuo-motor task, the MFV increased by a factor of 1.06 ± 0.07 in the right-MCA and by a factor of 1.08 ± 0.07 in the left-MCA. GLM and GAM showed a statistically significant change in MFV (GLM:F(2, 3598) = 16.76, P < .001; GAM:F(2, 3598) = 21.63, P < .001); together with effects of hemispheric side and gender (GLM:F(4, 3596) = 7.83, P < .005; GAM:F(4, 3596) = 2.13, P = .001). Comparing the models using the χ2 test for goodness of fit yields a significant difference χ2 (9.9556) = 0.6836, P < .001. CONCLUSIONS Both the GLM and GAM yielded valid statistical models of MFV in the MCA in healthy subjects. However, the model using the GAM resulted in improved fit indices. The GAM's advantage becomes even clearer when the MFV curves are visualized; yielding a more realistic approach to brain hemodynamics, thus allowing for an improvement in the interpretation of the mathematical and statistical results. Our results demonstrate the utility of the GAM for the analysis and representation of hemodynamic parameters.
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Affiliation(s)
- Stephan T. Egger
- Department of Psychiatry, Psychotherapy and PsychosomaticsUniversity of Zürich, Faculty of Medicine, Psychiatric University Hospital of ZurichZurichSwitzerland
- Department of Psychiatry, ISPA, INEUROPA, CIBERSAMUniversity of Oviedo, Faculty of MedicineOviedoSpain
| | - Julio Bobes
- Department of Psychiatry, ISPA, INEUROPA, CIBERSAMUniversity of Oviedo, Faculty of MedicineOviedoSpain
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and PsychosomaticsUniversity of Zürich, Faculty of Medicine, Psychiatric University Hospital of ZurichZurichSwitzerland
| | - Stefan Vetter
- Department of Psychiatry, Psychotherapy and PsychosomaticsUniversity of Zürich, Faculty of Medicine, Psychiatric University Hospital of ZurichZurichSwitzerland
| | - Daniel Schuepbach
- Department of General Psychiatry, Center of Psychosocial Medicine, University of HeidelbergUniversity of HeidelbergHeidelbergGermany
- Departmet of Psychiatry and PsychotherapyKlinikum am WeissenhofWeinsbergGermany
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Ouellette J, Lacoste B. From Neurodevelopmental to Neurodegenerative Disorders: The Vascular Continuum. Front Aging Neurosci 2021; 13:749026. [PMID: 34744690 PMCID: PMC8570842 DOI: 10.3389/fnagi.2021.749026] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 09/13/2021] [Indexed: 12/12/2022] Open
Abstract
Structural and functional integrity of the cerebral vasculature ensures proper brain development and function, as well as healthy aging. The inability of the brain to store energy makes it exceptionally dependent on an adequate supply of oxygen and nutrients from the blood stream for matching colossal demands of neural and glial cells. Key vascular features including a dense vasculature, a tightly controlled environment, and the regulation of cerebral blood flow (CBF) all take part in brain health throughout life. As such, healthy brain development and aging are both ensured by the anatomical and functional interaction between the vascular and nervous systems that are established during brain development and maintained throughout the lifespan. During critical periods of brain development, vascular networks remodel until they can actively respond to increases in neural activity through neurovascular coupling, which makes the brain particularly vulnerable to neurovascular alterations. The brain vasculature has been strongly associated with the onset and/or progression of conditions associated with aging, and more recently with neurodevelopmental disorders. Our understanding of cerebrovascular contributions to neurological disorders is rapidly evolving, and increasing evidence shows that deficits in angiogenesis, CBF and the blood-brain barrier (BBB) are causally linked to cognitive impairment. Moreover, it is of utmost curiosity that although neurodevelopmental and neurodegenerative disorders express different clinical features at different stages of life, they share similar vascular abnormalities. In this review, we present an overview of vascular dysfunctions associated with neurodevelopmental (autism spectrum disorders, schizophrenia, Down Syndrome) and neurodegenerative (multiple sclerosis, Huntington's, Parkinson's, and Alzheimer's diseases) disorders, with a focus on impairments in angiogenesis, CBF and the BBB. Finally, we discuss the impact of early vascular impairments on the expression of neurodegenerative diseases.
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Affiliation(s)
- Julie Ouellette
- Ottawa Hospital Research Institute, Neuroscience Program, Ottawa, ON, Canada
- Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Baptiste Lacoste
- Ottawa Hospital Research Institute, Neuroscience Program, Ottawa, ON, Canada
- Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- University of Ottawa Brain and Mind Research Institute, Ottawa, ON, Canada
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Egger ST, Bobes J, Rauen K, Seifritz E, Vetter S, Schuepbach D. Psychopathological Symptom Load and Distinguishable Cerebral Blood Flow Velocity Patterns in Patients With Schizophrenia and Healthy Controls: A Functional Transcranial Doppler Study. Front Psychiatry 2021; 12:679021. [PMID: 34248715 PMCID: PMC8267584 DOI: 10.3389/fpsyt.2021.679021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 05/21/2021] [Indexed: 01/03/2023] Open
Abstract
Introduction: Schizophrenia is a severe psychiatric disorder, with executive dysfunction and impaired processing speed playing a pivotal role in the course of the disease. In patients with schizophrenia, neurocognitive deficits appear to be related to alterations in cerebral hemodynamics. It is not fully understood if psychopathological symptom load (i.e., presence and severity of symptoms) is also related to alterations in cerebral hemodynamics. We aim to study the relationship between psychopathological symptom load and cerebral hemodynamics in the Middle Cerebral Artery (MCA) during a cognitive task in patients with schizophrenia and healthy controls. Methodology: Cerebral hemodynamics in the MCA were examined in 30 patients with schizophrenia and 15 healthy controls using functional Transcranial Doppler (fTCD) during the Trail Making Test (TMT). Psychopathological symptoms were measured using the Brief Psychiatric Rating Scale (BPRS). Patients were dichotomized according to BPRS scores: mild-moderate (BPRS < 41, n = 15) or marked-severe (BPRS ≧ 41, n = 15). Mean blood flow velocity (MFV) in the MCA and processing speed of the TMT were analyzed. Cerebral hemodynamics were analyzed using the general additional model (GAM) with a covariate analysis of variance (ANCOVA) for group comparisons. Results: Patients and healthy controls were comparable regarding demographics. Patients had a slower processing speed for the TMT-A (patients-severe: 52s, patients-moderate: 40s, healthy-controls: 32s, p = 0.019) and TMT-B [patients-severe: 111s, patients-moderate: 76s, healthy-controls: 66s, p < 0.001)]. Patients demonstrated differing hemodynamic profiles in both TMTs: TMT- A [F (6, 1,792) = 17, p < 0.000); TMT-B [F (6, 2,692) = 61.93, p < 0.000], with a delay in increase in MFV and a failure to return to baseline values. Conclusions: Patients with schizophrenia demonstrated slower speeds of processing during both the TMT-A and TMT-B. The speed of processing deteriorated with increasing psychopathological symptom load, additionally a distinct cerebral hemodynamic pattern in the MCA was observed. Our results further support the view that severity of schizophrenia, particularly psychopathological symptom load, influences performance in neurocognitive tasks and is related to distinct patterns of brain hemodynamics.
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Affiliation(s)
- Stephan T Egger
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, University Hospital of Zurich, University of Zürich, Zurich, Switzerland.,Department of Psychiatry, Faculty of Medicine, University of Oviedo, Oviedo, Spain
| | - Julio Bobes
- Department of Psychiatry, Faculty of Medicine, University of Oviedo, Oviedo, Spain
| | - Katrin Rauen
- Department of Geriatric Psychiatry, Faculty of Medicine, Psychiatric University Hospital of Zurich, University of Zürich, Zurich, Switzerland.,Institute for Stroke and Dementia Research, Ludwig Maximilian University Munich, University Hospital, Munich, Germany
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, University Hospital of Zurich, University of Zürich, Zurich, Switzerland
| | - Stefan Vetter
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, University Hospital of Zurich, University of Zürich, Zurich, Switzerland
| | - Daniel Schuepbach
- Department of General Psychiatry, Center of Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany.,Klinikum am Weissenhof, Weinsberg, Germany
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Siragusa MA, Réméniéras JP, Bouakaz A, Escoffre JM, Patat F, Dujardin PA, Brizard B, Belzung C, Camus V, El-Hage W, Desmidt T. A systematic review of ultrasound imaging and therapy in mental disorders. Prog Neuropsychopharmacol Biol Psychiatry 2020; 101:109919. [PMID: 32169563 DOI: 10.1016/j.pnpbp.2020.109919] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 03/06/2020] [Accepted: 03/09/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Increasing evidence suggests that ultrasound (US) imaging may provide biomarkers and therapeutic options in mental disorders. We systematically reviewed the literature to provide a global overview of the possibilities of US for psychiatry. METHODS Original English language articles published between January 2000 and September 2019 were identified through databases searching and analyzed to summarize existing evidence according to PRISMA methodology. RESULTS A total of 81 articles were included. Various US techniques and markers have been used in mental disorders, including Transcranial Doppler and Intima-Media Thickness. Most of the studies have focused on characterizing the pathophysiology of mental disorders, especially vascular physiology. Studies on therapeutic applications are still scarce. DISCUSSION US imaging has proved to be useful in characterizing vascular impairment and structural and functional brain changes in mental disorders. Preliminary findings also suggest potential interests for therapeutic applications. Growing evidence suggests that US imaging could provide a non-invasive, portable and low-cost tool for pathophysiological characterization, prognostic assessment and therapeutic applications in mental disorders.
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Affiliation(s)
| | | | - Ayache Bouakaz
- UMR 1253, iBrain, Université de Tours, Inserm, Tours, France
| | | | - Frédéric Patat
- UMR 1253, iBrain, Université de Tours, Inserm, Tours, France; CHU de Tours, Tours, France; CIC 1415, CHU Tours, Inserm, Tours Cedex, France
| | | | - Bruno Brizard
- UMR 1253, iBrain, Université de Tours, Inserm, Tours, France
| | | | - Vincent Camus
- UMR 1253, iBrain, Université de Tours, Inserm, Tours, France; CHU de Tours, Tours, France
| | - Wissam El-Hage
- UMR 1253, iBrain, Université de Tours, Inserm, Tours, France; CHU de Tours, Tours, France; CIC 1415, CHU Tours, Inserm, Tours Cedex, France
| | - Thomas Desmidt
- UMR 1253, iBrain, Université de Tours, Inserm, Tours, France; CHU de Tours, Tours, France.
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Cerebral blood flow responses during prosaccade and antisaccade preparation in major depression. Eur Arch Psychiatry Clin Neurosci 2019; 269:813-822. [PMID: 30421150 DOI: 10.1007/s00406-018-0956-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 11/03/2018] [Indexed: 12/17/2022]
Abstract
While impairments in executive functions have been well established in major depressive disorder (MDD), specific deficits in proactive control have scarcely been studied so far. Proactive control refers to cognitive processes during anticipation of a behaviorally relevant event that facilitate readiness to react. In this study, cerebral blood flow responses were investigated in MDD patients during a precued antisaccade task requiring preparatory attention and proactive inhibition. Using functional transcranial Doppler sonography, blood flow velocities in the middle cerebral arteries of both hemispheres were recorded in 40 MDD patients and 40 healthy controls. In the task, a target appeared left or right of the fixation point 5 s after a cuing stimulus; subjects had to move their gaze to the target (prosaccade) or its mirror image position (antisaccade). Video-based eye-tracking was applied for ocular recording. A right dominant blood flow increase arose during prosaccade and antisaccade preparation, which was smaller in MDD patients than controls. Patients exhibited a higher error rate than controls for antisaccades but not prosaccades. The smaller blood flow response may reflect blunted anticipatory activation of the dorsolateral prefrontal and inferior parietal cortices in MDD. The patients' increased antisaccade error rate suggests deficient inhibitory control. The findings support the notion of impairments in proactive control in MDD, which are clinically relevant as they may contribute to the deficits in cognition and behavioral regulation that characterize the disorder.
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Hoffmann A, Montoro CI, Reyes del Paso GA, Duschek S. Cerebral blood flow modulations during proactive control in major depressive disorder. Int J Psychophysiol 2018; 133:175-181. [DOI: 10.1016/j.ijpsycho.2018.07.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 06/13/2018] [Accepted: 07/05/2018] [Indexed: 02/06/2023]
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Laere E, Tee SF, Tang PY. Assessment of Cognition in Schizophrenia Using Trail Making Test: A Meta-Analysis. Psychiatry Investig 2018; 15:945-955. [PMID: 30223641 PMCID: PMC6212701 DOI: 10.30773/pi.2018.07.22] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 06/10/2018] [Accepted: 07/22/2018] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE The present meta-analysis aimed to analyze the cognitive performance of schizophrenia patients measured by Trail Making Tests (TMT) and the contribution of socio-demographic factors to cognitive impairments. METHODS PubMed and PsycARTICLES databases were searched for the studies published between January 1985 and November 2017. Data were drawn from 19 studies encompassing 1095 patients and 324 controls. The effect size and heterogeneity were assessed with Comprehensive Meta-Analysis version 2 using random-effect model. RESULTS Overall, the results showed that the schizophrenia patients performed significantly (p<0.001) worse than healthy controls in both TMT-A and B. However, concurrent substance abuse, clinical status (inpatient or outpatient), duration of education and duration of illness were not associated with cognitive impairment among the schizophrenia patients. CONCLUSION The present meta-analysis confirmed the cognitive processing speed and flexibility of schizophrenia patients were impaired. However, their duration of education, duration of illness and clinical status (inpatient or outpatient) were not the risk factors.
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Affiliation(s)
- Erna Laere
- Department of Chemical Engineering, Universiti Tunku Abdul Rahman, Kajang, Malaysia
| | - Shiau Foon Tee
- Department of Chemical Engineering, Universiti Tunku Abdul Rahman, Kajang, Malaysia
| | - Pek Yee Tang
- Department of Mechatronics and Biomedical Engineering, Universiti Tunku Abdul Rahman, Kajang, Malaysia
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Hoffmann A, Montoro CI, Reyes Del Paso GA, Duschek S. Cerebral blood flow modulations during cognitive control in major depressive disorder. J Affect Disord 2018; 237:118-125. [PMID: 29803902 DOI: 10.1016/j.jad.2018.05.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 04/23/2018] [Accepted: 05/13/2018] [Indexed: 01/25/2023]
Abstract
BACKGROUND This study investigated cerebral blood flow modulations during proactive and reactive cognitive control in major depressive disorder (MDD). Proactive control refers to preparatory processes during anticipation of a behaviorally relevant event; reactive control is activated after such an event to ensure goal attainment. METHODS Using functional transcranial Doppler sonography, blood flow velocities in the middle cerebral arteries of both hemispheres were recorded in 40 MDD patients and 40 healthy controls during a precued Stroop task. The font color of color words, which appeared 5 s after an acoustic warning signal, had to be indicated while ignoring word meaning. RESULTS Patients, as compared to controls, exhibited smaller bilateral blood flow increases during task preparation and larger increases after color word presentation. Response time was longer in patients irrespective of the match or mismatch between font color and word meaning. The blood flow increase after word presentation correlated positively with response time. LIMITATIONS Potential effects of psychotropic medication on cognition and cerebral blood flow could not be controlled. CONCLUSIONS The study revealed evidence of reduced cortical activity during proactive and elevated activity that occurs during reactive control in MDD. Deficient implementation of proactive control in MDD may lead to increased reliance on reactive control. The association between the blood flow increase after color word presentation and poorer performance indicates that deficient response preparation cannot be compensated for by reactive strategies. The findings are clinically relevant, as they may contribute to our understanding of the mechanisms relevant to cognitive impairments in MDD.
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Affiliation(s)
- Alexandra Hoffmann
- UMIT - Institute of Psychology, University for Health Sciences Medical Informatics and Technology, Eduard-Wallnöfer Zentrum 1, Hall in Tirol 6060, Austria.
| | | | | | - Stefan Duschek
- UMIT - Institute of Psychology, University for Health Sciences Medical Informatics and Technology, Eduard-Wallnöfer Zentrum 1, Hall in Tirol 6060, Austria
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Duschek S, Hoffmann A, Montoro CI, Reyes Del Paso GA, Schuepbach D, Ettinger U. Cerebral blood flow modulations during preparatory attention and proactive inhibition. Biol Psychol 2018; 137:65-72. [PMID: 30006269 DOI: 10.1016/j.biopsycho.2018.07.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 07/05/2018] [Accepted: 07/06/2018] [Indexed: 01/07/2023]
Abstract
This study investigated cerebral blood flow modulations during task preparation in a precued saccade paradigm. Bilateral blood flow velocities in the middle cerebral arteries were recorded in 48 subjects using functional transcranial Doppler sonography. Video-based eye-tracking was applied for ocular recording. Antisaccade and prosaccade trials were presented in both block-wise and interleaved order. A right dominant flow response arose during task preparation. While the response was stronger during antisaccade than prosaccade trials, the degree of lateralisation did not differ between the two trial types. Direction error rates were higher and latencies were longer for antisaccades than prosaccades. There were no differences between block-wise and interleaved trials in blood flow or performance. The stronger blood flow increases during antisaccade than prosaccade preparation reflects the complexity of the upcoming task demands as well as proactive inhibition. The right hemispheric lateralisation may be attributed to preparatory attention independent of demands on inhibitory control.
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Affiliation(s)
- Stefan Duschek
- UMIT - Institute of Psychology, University for Health Sciences Medical Informatics and Technology, Eduard Wallnöfer-Zentrum 1, 6060 Hall in Tirol, Austria.
| | - Alexandra Hoffmann
- UMIT - Institute of Psychology, University for Health Sciences Medical Informatics and Technology, Eduard Wallnöfer-Zentrum 1, 6060 Hall in Tirol, Austria.
| | - Casandra I Montoro
- UMIT - Institute of Psychology, University for Health Sciences Medical Informatics and Technology, Eduard Wallnöfer-Zentrum 1, 6060 Hall in Tirol, Austria.
| | | | - Daniel Schuepbach
- Hospital Weissenhof, Weinsberg, Department of General Psychiatry, University of Heidelberg, 74189 Weinsberg, Germany.
| | - Ulrich Ettinger
- Department of Psychology, University of Bonn, Kaiser-Karl-Ring 9, 53111 Bonn, Germany.
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Extrapyramidal symptoms in schizophrenia: evidence of blunted cerebral hemodynamics during a planning task. Int Clin Psychopharmacol 2017; 32:225-230. [PMID: 28181956 DOI: 10.1097/yic.0000000000000171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Acute extrapyramidal symptoms (EPS) occur frequently in schizophrenia, mostly caused by antidopaminergic substances. There have been no published reports on the impact of acute EPS on cerebral blood flow (CBF) or related measures. In the following study, we examined schizophrenic patients with and without EPS during a planning task and measurements of CBF velocity. Sixteen patients with chronic schizophrenia and 16 healthy participants performed a planning paradigm during bilateral functional transcranial Doppler sonography of the middle cerebral arteries. Patients with acute EPS showed blunted CBF velocity exclusively during difficult planning tasks, and correlation analyses confirmed that higher EPS scores were associated with reduced adaption of CBF velocity. EPS in schizophrenia are associated with a detrimental effect on CBF velocity. Hypothetically, compromised adaptation of cerebral hemodynamics during difficult, but not during easy planning tasks is one correlate of dysfunctional frontostriatal circuits in schizophrenic patients with EPS.
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